Provider Demographics
NPI:1104877760
Name:CUNDIFF, RANDALL K (ARNP)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:K
Last Name:CUNDIFF
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 803929
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-3929
Mailing Address - Country:US
Mailing Address - Phone:800-953-0104
Mailing Address - Fax:303-765-6670
Practice Address - Street 1:311 E SPRUCE ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-5614
Practice Address - Country:US
Practice Address - Phone:620-275-3030
Practice Address - Fax:620-275-3025
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44884363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100338290CMedicaid
KS100338290CMedicaid
KS161455Medicare ID - Type Unspecified